DR. D.H. SUKHWAL HOSPITAL DESIGNING & PLANNING

Aim  To build a hospital that is functional, efficient and yet economical without compromising on the design aspect 2

Objectives Provide a functional design that ensures efficient, safe and appropriate work space. Accommodate technical requirements for highly sophisticated equipment. Create clear, segregated paths for movement of people and material within the building. 3

Objectives.. Create a humane environment for patients and staff. Develop building systems that can accommodate rapid change. Blend technical and functional requirements into a design that brings delight to those who use the building and those who pass by it. 4

STEPS  Decision to build the hospital  A detailed architect’s brief  Architect drawing up his plans with consideration of landscape, facility mix, bed mix, availability of utilities in the vicinity  Inputs from other agencies like air- conditioning, electrical, plumbing, etc. required to finalize the working plan for the building 5

 Inputs from the equipment vendors especially in specialty areas like Cath- labs, CT-scanners, MRI, linear accelerators, operation theatres etc. essential  Emphasis to be given to support services like kitchen, laundry, CSSD, back-up electricity  Should be properly planned: Vital services with high capital costs & recurrent expenses 6

Planning & Design Team Functional complexities in hospitals are more than physical complexities; so we require persons who understand not only the work process of individual departments but those of the hospital operating system as a whole 7

Planning & Design Team..  Required: analysis of functional needs, understand interrelationship of departments, area requirements, major equipment, the grouping of accommodation and the main outline of traffic flow 8

Standards followed  India: total area per bed is hardly 600 sq. ft.  Western standards: 1,400 – 2,000 sq. ft. per bed  WHO recommends an area of sq. ft per bed 9

FUNCTIONAL PLANNING Functionality is a prime determinant of operational efficiency in the total life cycle cost of all hospital structures 10

functional planner takes care of.. Functions Locations Relationship Utilization Functional planner is a trained hospital administrator who is capable of interpreting complex relationships, internal traffic flows (personnel and supplies) 11 Staffing pattern Space requirements Work flow

Functional planner also takes care of.. Technological requirements Operational procedures Product of beauty Reasonable cost Optimal utility A functional design: promotes skill, economy, conveniences & comforts. A nonfunctional design: impedes activities of all types, detracts from quality of care & raises costs 12

functional planner With Architect : Physical evaluation of existing facilities Space programming Master site planning Functional evaluation of existing facilities Preparation of workload projections Functional programming 13

Physical evaluation of existing facilities  This is a study to determine the degree of physical obsolescence of existing facilities and to identify major code violations and physical problems and to project future usability. 14

Space programming Based on functional program amended & approved by hospital a room by room listing is made of all areas in proposed project Net square footage is assigned to each space, & totals accumulated for every department or functional entity using net figures Appropriate calculations are then made to set gross totals for each department or functional entity as well as the total for entire project 15

Functional evaluation of existing facilities Here we define functional problems (that detract from operational efficiency, quality of patient care, and convenience of building inhabitants); to evaluate traffic flows & physical relationships to determine space insufficiencies in terms of current requirements to study need for modernization, alterations & expansion, according to strategic plan findings to note possible alternative future uses of structure as a whole as well as of various departmental areas 16

Preparation of workload projections  Functional planner determines & formulates concepts of operation for proposed project according to previous study findings.  These concepts are incorporated in functional program  These projections form the basis for functional programming, revenue projections & staffing estimates 17

Functional programming Formulating recommendations for operational concepts Detailed room composition of project, required phasing, alterations, internal & external traffic flows, interdepartmental relationships & operating systems Using approved recommendations & findings of strategic plan, findings of physical & functional evaluations & workload projections, functional planner formulates the activity 18

Architect’s brief Written program explaining the above requirements With this written program’s help, architect prepares schematic drawings and sketch plans Helps the architect to build a functional, economical and efficient hospital. 19

Architect’s brief contains.. Permission required from various regulatory bodies Spatial needs of various departments Manpower required Special requirements of various departments Inter and intra departmental relationships 20

Issues that need to be addressed  Flexibility for future expansion  Larger secondary areas for better patient comfort  Proper utilities for waiting areas  Nurse stations  Storage  Changing rooms 21

Alcoves for stretchers/ wheelchairs Adequate transport facilities Parking facilities Proper light and ventilation Time & trouble spent during this stage will be well repaid & enable whole project to proceed smoothly with minimum subsequent revision 22 Issues…

Market survey  To primarily know the deficiencies in the health care market, so that we can decide proper facility & bed mix  To help us finalize size of the project  For existing hospitals to undertake benchmarking in areas like tariff rationalization, compensation policies, utilization reviews for various services etc. 23

Market survey.. Of..  Households  Medical professionals  Diagnostic centers  Nursing homes  Hospitals  Relevant data from census report, demographic surveys, government/ media publications etc. 24

Feasibility Reports  Brief description on major findings of market research  Proposed facilities plan  Detailed project cost: land & building, medical & non-medical equipment, furniture & fixtures, utilities, pr-operative costs, contingencies, working capital requirement, means of finance 25

 Income and expenditure projections based on the feedback from the market research and available database  Profit and Loss/ Balance sheet/Cash flow statements  Break even analysis  Sensitivity analysis 26 Feasibility...

Specialized healthcare architecture  Healthcare architecture requires specialized knowledge on part of architect & supporting engineering team  Stringent functional demands  Improves quality of environment for patient & caregivers  Meets needs of people using such facilities in times of uncertainty, stress, & dependency on doctors & nurses 27

 Recognize & support patients' families & friends by providing pleasant spaces  Project an underlying reassurance that patient is in hands of competent medical staff & in a technically sound healthcare facility  Convenience, caring encounters, service orientation and quality of care 28 Specialized healthcare architecture..

Project Management Liaison with all Agencies - Architects/contractors/equipment vendors/utility service consultants and suppliers Monitoring Project with PERT/CPM Managing Change in Project Plans - most vital & complicated component due to various fall outs from change in project design Managing equipment planning schedule including cost-feature analysis, procurement process, installation etc. 29

Project Management.. Architectural Designing Project Management Turn Around Strategies 30 Operational Audits: o Improvement of the lab services o Operation theatre utilization reviews o Manpower audits o Medical audits o Infection control programs o Reorganization of profit centers o Support service audits etc.

Project Management..  Costing of Services  Systems Study & Re-design  Manpower Audit & Training  Marketing Strategies  Biomedical Equipment - Planning & Procurement Norms 31

Product Development  Benchmarking regarding market expectation from a hospital management system  Hospital best practices  Reviews of newer modules and upgrade versions and provide recommendation of any enhancements/modification  Periodic comprehensive review and study of the existing modules to update and upgrade continuously 32

Implementation  Implementation plan with solution  A comprehensive system study  Gap analysis  Preparing specification for customization  Site monitoring  Audits of the sites where software is already installed to identify areas of problem  Business development in terms of identifying new leads, identify right business partner 33

Good planning is critical to the hospital’s success  If a hospital has to be successful it must be built on bedrock of three sound principles namely:  good planning,  good design & construction  good management 34

Efficient, Functional and economical hospital  real test of any hospital is: quality of healthcare it provides  minor defects in designing could make operation of a hospital inefficient  inefficient hospital costs significantly more to operate staff & maintain: patients within it get less health services for money they pay 35

 The initial cost of building a hospital is insignificant when compared to the cost of running and maintaining it over the years-  by one reckoning eighteen to twenty times over a period of twenty years 36 Efficient, Functional and economical hospital…

Efficient, Functional and economical hospital..  Another study says that running cost of a hospital over 4 to 5 years from the date of completion is about the same as the capital cost  if the facilities are not planned & designed properly the intangible cost can be enormous  efficiency with which physicians & their assistants can function is greatly handicapped by obsolete design 37

Patient comfort & provision for expansion is often overlooked. Growing efficiency & innovative ideas have revolutionized hospital building construction to meet special needs of patients A pleasant environment that makes for enthusiastic & more productive staff also benefits patients indirectly 38 Efficient, Functional and economical hospital…

Many patients complain that hospitals reduce privacy, individuality & more importantly human dignity. Many of these details & facilities can be incorporated with little or no extra cost. So, patient’s needs & expectations should be kept uppermost in mind & any design should aim at his satisfaction & comfort 39 Efficient, Functional and economical hospital…

These factors are again influenced by rapid changes and advances that are taking place in fields of technology & medicine & constant need to modernize, renovate, replace & expand healthcare facilities 40 Efficient, Functional and economical hospital…

Process of planning A common understanding is required between ; ON ONE HAND: ARCHITECT & ENGINEERS ON OTHER HAND: PROMOTERS, DOCTORS, ADMINISTRATORS & PLANNERS Next step is operational plan for each department to decide; LOCATION of each department, requirement of FLOOR SPACE, intradepartmental & interdepartmental RELATIONSHIPS, CIRCULATION, TRAFFIC FLOW and requirements IN RELATION TO equipment, personnel & patients 41

Operational & Functional planning first  Operational planning is a written document for any architectural project:- Services, number of beds, departmental functions, departmental needs, major equipment, space requirements, required personnel, relationships and adjacencies are included here.  Dept-by dept description of needed space  current and projected needs within the facility 42

Operational & Functional planning first  Normally there is either no briefing of the architects or the brief given to him is inadequate  They are asked to prepare building schedules with the help of doctors OR  Observe other hospitals & take guidelines from them. Both these are unsatisfactory methods. Promoters must clearly tell architect the requirements of hospital & not the other way round 43

Key to Functional planning  The proper sequence is;  First: Develop operational planning that defines major requirements & needs.  Next: Operational plan is developed into a functional plan i.e. planning of the hospital on a functional basis-that lists every room & suggests net sizes for major functional rooms &total size of the department. 44

Mistakes in planning may prove costly  Functional grouping of high traffic areas such as X-ray, laboratories, surgical & delivery suites, physical therapy & clinics on two floors is desirable  It permits concentration of hospital activities in a manageable unit.  When future expansion or change becomes necessary, they can be accomplished without disturbing other areas 45

 Operational Plan & Functional Plan must precede Architectural Plans Otherwise;  Within 5–10 years, it is found that cost of construction equaled or surpassed by operating expenses 46

Hospitals must be planned for future  A fundamental rule is; hospital should be planned for at least 10 to 15 years ahead or else plans will be obsolete  Well planned systems must be built to keep pace with the changes  `Smart` hospitals that respond to present needs while anticipating future change; should be built 47

Hospitals must be planned for future…  All departments are planned in such a way that they stand out individually  Each department with space around for expansion.  Future expansion is rendered easy with free ended buildings with extendable corridors  Expensive permanent fixtures & fixed equipment such as plants & elevators are not located at free ends of the departments as they would permanently block expansion plans 48

Space Plan 49

‘Design follows function’  Architect finalizes his plans, with help of;  personal interviews with hospital administrators experienced in building hospitals  literature review  For a 100 bedded hospital, total space area including the parking space, HVAC & water is 1,05,319 sq ft which works out to be sq meter.  Modern standards of constructing hospitals requires; sq ft per bed. 50

Ground Floor  Key Departments like OPD, Emergency, Radiology, Laboratory should be on the ground floor.  Radiology dept. should be near Emergency dept. 40% of cases coming to Emergency require X rays 51

First floor  Administration department  Blood bank  General and Pediatric wards 52

Second floor  Labour room  Obstetric ward  NICU  Semi-private ward  CSSD just below the operation theatre with provision for dumb waiters between the CSSD and the OT 53

3 rd floor  ICU  Private wards  OT 54

4 th floor  Residential area just above ICU & OT. So a doctor can easily attend the patient when called  30% of the area is kept for circulation 55